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My Mom (92) has been in a NH for about 1.5 years after setbacks after a major surgery. She had shingles 40 years ago and lost most her her right eye vision, lately she has had a second bout of shingles, 2 major UTIs, and has lost most of her left eye vision due to the shingles. When her vision detiorated, so did her walking (I think due to fear), and had to stop PT, and she got weaker and she is now in her wheelchair and 2 assist. I estimate her to be about a level 6 in dementia, but she is still so happy and singing, and is still pleasant and fun to be around, and I visit her daily to hang out and help her with her lunch.
My problem is with her frequent falls lately. Since December she has fallen from her bed 4 times, 3 with injuries. She’s has slid/fallen from her wheelchair 4 times, latest was last night. I’ve met with the Nurse Manager, the NP, the DON, and the Ombudsman for ideas and to impress the need to keep her off the floor. In NY you cannot restrain residents in any way and even her wheelchair alarm has been removed as considered a restraint. So we are looking for ways to prevent falls, or at least minimize the damage to herself if/when she does fall. So far we have implemented theses precautions but I’m grasping for more ideas to keep her from injuring herself if/when she falls:
She is on 15 minute bed checks.
Got her a wheelchair pad with more traction. She still managed to fall from it last night however.
Got her a wider twin bed, and lowered it to the floor.
Placed pads on the floor on each side of the bed.
Moved tray table and wheelchair away from the bed while sleeping.
Padded sharp corners on her low furniture like footboard and a/c unit.
Placed her pillows to kind of make her a well in the bed (I was told this is considered a restraint so we do it on the downlow)
Placed her call bell disc near her bum so if she rolls that way it goes off.


Does anyone have any more ideas?? I’m really afraid she’s going to break a bone one of these times and that will be the end of it. Thanks so much!

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Thank you all for your answers! I did have a nice impromptu meeting yesterday with the new RN Manager for her floor. She has recently been hired from a hospital setting and is very upset at the casual regard that falls are given in the NH. She came from a setting where your patients fall was almost a fireable offense. We reviewed all that’s being done and she had a few more ideas. She wants Mom to be toileted more often, in case Mom is "attempting" to go to the bathroom when she falls, and also thinks a Scoot chair will help keep her more comfortable and seated. She showed me some residents that have them and it seems like a good idea, but she says they are "hard to come by". They're $2300 so that’s probably the reason. I might offer to pay the difference between a regular chair vs scoot chair that might help? She also has started a Fall Roundtable with other RNs there to brainstorm the issue of falls. If we do get her a scoot chair we will need to move her bed closer to the wall so there’s clearance for the chair so that will help too. I came away encouraged that she is very serious about this issue and will be an ally.
Yes I am so lucky that Mom is still happy. Every day she tells me she loves me and thanks me for being with her, and sings You Are My Sunshine and just wants me to hold her hand. My heart breaks for the caregivers on this forum who experience verbal abuse and worse from their loved ones. I pray for patience and kindness for them along with Moms CNAs.
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My husband fell in a hospital room, with me and a nurse in the room.

At home he fell in the bathroom and landed in the tub. Our daughter was in the room with him. She felt absolutely terrible. I assured her over and over that it wasn't her fault.

Old people fall. Persons with dementia fall. Old persons with dementia have two strikes against them. It sounds like the NH is handling this appropriately. There really few ways to prevent fall completely. One would be physical restraint. Not Good. The other is chemical restraint. Just as bad.

You are a very conscientious caregiver. You have tried your best to do what you can and also engaged professions for solution. There may not be much more you can do, except visiting regularly -- and you are already doing that.

I hope that this doesn't seem morbid or uncaring. I found that once I accepted that my husband and my mother had fatal diseases it was easier to put things in perspective.

Your description of your mother sounds like mine: "she is still so happy and singing, and is still pleasant and fun to be around." Isn't that great? I feel so sorry for people whose loved ones who are anything but pleasant. You and I are luckier in that regard.
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I know what you are going through. My own Mom [also in her 90's] was an escape artists from her bed, her wheelchair or geri-recliner. But was no longer able to walk or even stand. Constantly falling. The facility was trying everything that your Mom's facility was doing.

The pillows did work in my Mom's case. When Mom went to bed, pillows were stuffed in all around her, like the nurses did for your Mom. That kept her from falling out of bed, but it make it difficult for Mom to turn over by herself.

No more wheelchair, Mom had to use a geri-recliner where pillows were placed under her knees. That kept her secure for awhile until she was able to pull those pillows out, but it took a lot of time and energy for Mom to do that. Mom was parked at the nursing station most of the day.

Only other suggestion is to hire a sitter to be with Mom during the day. But that sitter would need to be glued to the hip with Mom. Only time the sitter could take a bathroom break is if a nurse or aide could watch Mom. Sometimes when mother nature calls, you just can't wait. And even our love one is sound a sleep, someway, somehow, they will find a way to quickly wake up and fall... [sigh].
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You’re doing all the good stuff but she’s gonna keep falling. I’m going through this now with my mom in AL. They have a great staff, rarely 15 minutes go by that someone is not peeking in.

Bad falls are what put her in care and she’s had 3 more in the 2 months she’s been there. Now she has a broken clavicle from a fall 2 days ago. With her dementia she doesn’t remember that she needs assistance and keeps trying to get up.

There are no magic bullets for this.
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My step grannie sounds just like your mom, happy smiling singing and falling, there was a big foam insert to go in the front of wheelchair on her lap, it was marketed as a spinal product. It kept her from falling out of the wheelchair and if she wanted to, with work she could have removed it. Easy in and out for an able bodied person. Have you tried putting her bed against the wall to allow only one-sided danger?

Unfortunately as we age our mobility and stability suffer.

Best of luck finding the solutions that work best for mom.
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Great input!

I don't understand why restraints became so bad if it was a SAFETY issue (I'm not talking about tying someone to the bed!).
I think the states went from one extreme to the other...anything went at one time, and once they realized what was happening (the horror stories), laws were passed in extreme fashion. There has to be a happy medium!

I would like to start a national movement about this issue....
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I’ve had lunch and dinner at the AL where my folks are numerous times. As I was sitting at dinner one night looking at my beat up and bruised mom, I notice that almost everyone at the table had bruises from falls. Average age, late 80s.

So I look around the dining room. Everywhere you look are bruises, heads stitched up, casts on arms and legs.....

And this is a private pay place with a higher staff to resident ratio. You can walk the halls here and you are never out of sight of a staff member.

And all the residents have the call button pedants to use for assistance but few, if any, remember to use them. And there are bed alarms, mats by the beds, bolsters in the wheelchairs etc.

Big government banning restraints? Yes it does seem easier if we could just lock em down but here’s the first post we’d see on this forum if that were still allowed:

OMG! NURSING HOME HAD MY MOM STRAPPED DOWN IN BED! CAN THEY DO THIS?!

When mom was still home and I was visiting she’d try to get up. I’d grab her walker, get her up and steady, and 30 seconds later hear her tumble in the bedroom.

For caregiver/families the falls are the most frustrating aspect of getting old.
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It is a common thing to see people at the nursing home using their feet to propel their wheelchairs, I don't think a special chair is necessary or even the best option.
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My Mom fell in rehab 6 times in 9 days. She forgot she broke her pelvis and back. That's how i arrived screaming on this forum! They got her a little low wheelchair with no leg or footrests. She "walked" with her feet like cwillie said. The NH tried everything like they are doing for your mom. More Dementia added from the hospital stay just made my Mom forget. I know it can drive YOU crazy! Hang in there!
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Sorry, not sure how to attach a picture
optimaol.com/product/dyn-ergo-scoot-chair/
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